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Karlie Lorenz Lorenz 1

Jay Varner


1 April 2016

Americas Silent Killer: Toxic Stress

What if I told you that there was a toxic chemical that could threaten the well-being of

millions of people? This toxic substance could increase the risks of a host of physical and mental

health issues including asthma, heart disease, diabetes, reproductive complications, strokes, heart

attacks, depression, anxiety, ADHD, and even stunts in brain development. This substance could

also amplify complex social, cultural, communal, and developmental issues. Those exposed to it

would be more prone to drug addiction, smoking, alcoholism, sexually transmitted diseases, teen

pregnancy, domestic and child abuse, and even suicide. Consequently, this toxin would be

responsible for the inability of those affected to maintain healthy lifestyles- hindering their

ability to achieve academic success, find employment, and maintain stable relationships. It

would completely consume their lives, and the symptoms would even be passed down to their


A substance like this would be avoided like the plague, for it would be comparable to

cancer, HIV, or radioactive matter. Our government would work tirelessly to prevent and reduce

its effects. Policies would be implemented to protect those affected, and billions of dollars would

be spent to mitigate the effects of this harmful toxin. We would stop at nothing to prevent our

children from being exposed to it.

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This toxin is real- its called toxic stress. It is one of the most detrimental public health

issues that those in poverty face, influencing ones mental and physical health as well as altering

the architecture of ones brain. How can stress lead to so many health disparities? you may

ask. What makes those in poverty more vulnerable to toxic stress? Scientists are able to

distinguish between three types of stress responses- positive, tolerable, and toxic stress. Each is

characterized by varying levels of intensity and duration of the stress response system (Shonkoff

and Bales 27).

Positive stress is associated with brief concerns like studying for an exam or preparing for

a job interview. In small doses, these experiences are actually beneficial to our development, as

they strengthen our abilities to combat anxiety. Positive stress may even be a motivating factor

that leads to success, pushing us to reach our goals. Tolerable stress extends beyond deadlines

and is related to serious concerns like mourning the loss of a family member or experiencing a

natural disaster. Although these stressors are serious and traumatic, they arent a threat to the

victims long-term well-being if he or she has the relational support of family and friends.

Conversely, toxic stress results in experiencing chronic and persistent traumatic events in the

absence of such guidance and connections. Examples of these adverse experiences include

parental substance abuse, a low socioeconomic status, violence, abuse, neglect, and addiction,

among a host of others. These realities are typical in the lives of those living in poverty,

especially those living in unstable households. Research has proven that this exposure to

violence causes extreme anxiety, constantly disrupting the bodys stress response system.

(Shonkoff et al.1)

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When most people think of stress they think of the fight or flight system- a lion is about

to attack you, and your body must prepare for survival. In the words of Walter Cannon, the

Harvard physiologist who discovered this phenomenon, this response actually corresponds to an

area of our brain called the hypothalamus, which- when stimulated- initiates a sequence of nerve

cell firing and chemical release that prepares our body for running or fighting (5 Minute Stress

Mastery 1). The body is hard-wired to release chemicals like adrenaline and cortisol into the

bloodstream, preparing us for survival mode. The immune and digestive systems are shunted,

as our energy will be used for fleeing or fighting. Our pupils expand, blood thickens, and our

primitive instincts take over, losing our capability to think logically (5 Minute Stress Mastery


Toxic stress is fight or flight on overdrive, but it isnt a lion that threatens someones

survival. Often times its a childs abusive parent or violent neighborhood. In most cases, these

people arent able to fight or flee, leaving their stress response systems to be constantly

activated. Advances in the ecobiodevelopmental sciences claim that significant levels of stress

hormones can lead to serious medical complications. This excessive flow of stress chemicals in

the blood disrupt the brain circuitry and other organ and metabolic systems during sensitive

developmental periods (Shonkoff and Garner 239). When these systems are irritated, the body

is more susceptible to disease and mental health disparities.

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Results from Dr. Vincent Felitti and Dr. Robert Andas Adverse Childhood Experience

(ACE) Study revealed that stressors contributing to toxic stress during childhood lead to serious

health and social disparities later in life. They evaluated the implications of adverse childhood

experiences- such as poverty, neglect, abuse, and addiction- on 17,000 middle-class citizens in

San Diego, finding a strong correlation between their level of stress and health issues. They

particularly studied the impact of abuse and household dysfunction in the lives of children,

examining their psychological, physical, and sexual encounters. They found a significant

relationship between the number of childhood exposures and the following disease conditions:

ischemic heart disease, cancer, chromic bronchitis, history of hepatitis or jaundice, skeletal

fractures, and poor self-rated health (Felitti et al. 250). Their results were shocking;

approximately 67 percent of the participants had at least once ACE, and 12.6 percent had four or

more ACEs. Felitti and Anda also claimed that ones amount of adverse experiences correlates

with his or her engagement in risky behaviors- such as smoking, alcoholism, and unprotected

sex. However, even if they werent involved in such behaviors, they are still twice as likely to

have heart disease. Its not just about risky behaviors; the reality is that these adverse experiences

affect the bodys immune, digestive, and hormonal systems, thus influencing how the brain

develops. These problems all stem from a stress response system on overdrive, diminishing the

quality of ones logical capacities.

Director of the Center on the Developing Brain at Harvard University, Jack P. Shonkoff,

explains how toxic stress physically alters the architecture of the developing brain. The plasticity

of the brain during the first five years of life is what makes childhood adversity so detrimental.

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Early childhood experiences influence the maturation of the brain; it is much easier to build a
strong foundation than it is to fix behavioral issues later (Shonkoff and Bales 25). During

childhood, the brain is constantly making neurological connections, and pruning the synapses

that it doesnt use. The events occurring in a persons life help determine what connections are

strengthened or die; if ones environment is dangerous, those synapses either dont connect to

begin with or develop abnormally. In other words, if a child doesnt learn emotional regulation

or social scripts early in life, he or she will suffer from extreme difficulty in developing

interpersonal skills in adulthood. If a child grows up in a toxic environment, he or she will have a

brain that has been adapted to have attachment issues and to overreact to the most minor of

complications. The public generally views child development as some combination of genes,

fate, free will, parents, and environment that is stirred up within the mystery of the proverbial

black box (Shonkoff and Bales 24). We fail to realize that child development is a societal

problem. When a persons stress response system is permanently activated, the amygdala and

hippocampus- parts of the brain responsible for fear conditioning- are underdeveloped.

Heightened stress also stunts the maturation of the prefrontal cortex- the region of the brain

responsible for impulse control, focusing attention, and logical decision making. These

detrimental effects impair ones ability to learn and establish healthy relationships.

A perfect example of this is Sarah, a seven-year-old girl living in Trenton, New Jersey-

her name has been changed to protect her privacy. She is one of eight children, raised by a single

mother who cant afford to support her family. Trenton was once a thriving city, but it has been

destroyed by the drug trade and gang violence. Homelessness and prostitution are prevalent on

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the streets, and violence permeates into the lives of its citizens- Trenton is no place for a little

girl to grow up. Sarah is a product of her environment; her previous adverse experiences have
left her with the incapacity to regulate her emotions. She is constantly pent up, overreacting to

trivial concerns and unable to sit still or focus her attention.

The problem isnt her personality; she cant focus in school because her brain is busy

preparing to react to threats from her environment. Often times, children living in poverty have

difficulties learning because their brains simply arent there. Studies have concluded that

multiple adverse experiences significantly impair a childs learning ability, putting them at a

disadvantage in the classroom, workplace, and community (Shonkoff et al. 5). Their findings

have even been supported by experiments with primates and rodents, strengthening the belief

that brain development- especially in regards to the prefrontal cortex- is the core problem.

Humans experiencing chronic stress have been shown to perform poorly on tasks related to

prefrontal cortex functioning (such as working memory or shifting attention), and their ability to

control emotions is typically impaired (Shonkoff et al. 6).

Schools are packed with children with misdiagnosed learning disorders like attention

deficit disorder (ADD) and attention deficit/hyperactivity disorder (ADHD), with the root of the

problem stemming from a toxic environment. Twenty years ago, teachers reported that they had

two or three of these children in their classroom. Now we hear that they have six or seven

(Karr-Morse et al. 38). Sarah falls into this category; she is unable to listen, focus, or regulate her

emotions. A day doesnt go by where she is isnt restless at her desk or picks a fight with another

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child. In addition to reacting to violence, she is often the instigator. These children are desperate

for any type of structure in their lives; they need consistency, attachment, comfort, and

discipline. Their experience with poverty and violence has led them to adjust their emotions,

with their physiological responses preparing them for the worst.

It may seem like common knowledge that socioeconomic status is a determinant of a

healthy life, but there is little discussion on why this happens or what we can do to change it. The

American Dream is based on the idea that if you work hard enough, you will succeed in life.

Education is seen as the key to achieving a high economic and social status, but how will that

dream play out for children like Sarah? How will she be able to find employment when the

education system has failed her? Economists suggest that the single strongest indicator of

mortality is income level (Isaacs and Shroeder 1140). Poverty contributes to a lack of control

over ones life circumstances, increased social isolation, and the anxiety brought about by a

subjective feeling of being of low social status (all of which can be compounded by racism)

(Isaacs and Shroeder 1141). Social inequality is what fosters toxic stress, ultimately leading to

the extreme income gap between the rich and poor.

Society expects people living in poverty to pick themselves up by their own bootstraps,

attributing their situation is an indicator of their work ethic. By believing that mental illness is

simply the result of ones individual behavior, we fail to understand that people have diseases

because of their toxic environments and adverse experiences. In a community filled with poorly

educated low-income citizens, economic hardship isnt the sole determinant of poor health;

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distributive egalitarianism wont solve this problem as much as tissues help a cold. Lack of

income goes hand-in-hand with violence, seriously impacting ones psychological health. It even

puts people at high risk for mental health issues that often correlate with drug abuse and

alcoholism. This, in turn, disrupts education, and even promotes things like teen pregnancy and
unemployment, leading to further neglect for the future generations who will fall victim to this

cyclical problem. Poverty is often seen as a one-dimensional problem, but few realize just how

complex the issue is. The toxic stress resulting from living in a dangerous environment

influences ones social, emotional, cognitive, and behavioral capacities.

Although a low socioeconomic status is one of the greatest indicators of toxic stress, we

cant just simply alleviate the income gap, as this is only natural in a capitalistic society.

However, I believe that we should be focusing our attention on equalizing our capabilities

because well-being cannot simply be defined by wealth. According to Johnathan Wolff, a

professor of philosophy at the University of College London, Increasing a persons income and

wealth may be a relatively ineffective way of improving his or her capabilities if the physical and

social world remains unwelcoming (Wolff 8). Unfortunately, our society is so infatuated with

the idea of wealth and status that the poor live in an extremely unwelcoming and judgmental

world. The discrimination due to our social differences has been rooted in the history of our

nation; people of different genders, religions, and races were once believed to be members of

different subspecies of the human population. Our differences have defined our dignity, and this

is why minorities are especially vulnerable to toxic stress.

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When a person lacks autonomy over ones environment, their vulnerability is what leads

to their isolation. Wolff also notes the importance of affiliation, and of emotions, which will

often depend on the nature of ones connection to others as part of individual well-being

(Wolff 14). Above all, we must ensure that everyone is equally regarded as entitled to a

worthwhile place in society, and not merely a fair share of resources. The relational
egalitarianism that Wolff suggests is imperative for the mitigation of toxic stress. As previously

mentioned, people who have had adverse experiences are able to avoid toxic stress if they have

stable relationships. This is what separates toxic from tolerable stress-positive, stable, and

reliable connections act as a buffer for children from the uncertain, dangerous environment in

which they live.

How do we foster healthy relationships in these toxic households? you may ask. A

comprehensive body of research conducted by Ignacia Arrubarrena and Joaquin de Paul from the

University of the Basque Country, claims that perhaps our only hope in eliminating this problem

is through early childhood interventions. Their research evaluated various early intervention

programs, usually home visiting services starting at pregnancy or early childhood. The most

successful program was the Nurse-Family Partnership Program, a home intervention program

performed by specialized nurses who provide caregivers and children support. They focus on

improving parental skills with increased communication and educating families on the issues of

maltreatment and abuse. The program lasts two years, starting at birth. They help the children

develop by fostering stable relationships between family members, and they even encourage

adults by helping them complete their education and find employment. The results are

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promising, with consistent effects on prenatal health behaviors, parental care of the child, child

maltreatment, child health and development, maternal life course, and criminal involvement of

the mothers and children (Arrubarrena and Paul 123).

The Human Capital Theory explains that improving the early development of our

children is a lucrative investment towards advancing our society and economy. The term human

capital encompasses the productive capacities embodied in people and may include knowledge,
health, experience, skills, and other characteristics (Kilburn and Karoly 1). Investments in our

nations youth are much more efficient than attempting to resolve the implications of toxic stress

later. For example, public investments in adult job training and substance abuse prevention have

been largely unsuccessful. Implementing programs that target the younger generation allows

children living in poverty to experience healthy development; this, in turn, prepares them to be

productive citizens.

Economists claim that a growing body of program evaluations shows that early

childhood programs have the potential to generate government savings that more than repay their

costs and produce returns to society as a whole that outpace most public and private

investments (Kilburn and Karoly 11). The Nurse-Family Partnership Program is a perfect

example of this. In the evaluations of the program, researchers found that that participating

children visited the ER 0.54 fewer times between the ages of two and four than did

nonparticipants (Kilburn and Karoly 14). Multiply .54 by the average cost of an ER visit: $432

(Machlin 2) and the average reduction is $228. This data was collected in 2003, so using a price

inflator to convert this information results in a value of 295 (2016) dollars. Monetary gains from

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early childhood intervention would also be seen in the reduction of crime and addiction. We can

either pay now to prevent toxic stress from destroying our children or pay even more to fix their

failures later in life.

Toxic stress is one of the deadliest public health issues that those in poverty face, and yet

our silence fuels its perpetration. America needs a wake-up call. We must rise beyond our

socioeconomic challenges in order to secure a promising future for every child in our nation.
Poverty and inequality are at the root of this crisis, and it is imperative that we do our best to

provide equal opportunities for all of our citizens. Once we recognize the importance of healthy

childhood development, we will not only improve the lives of millions of people, we will save

billions of dollars that are spent on health care. With increased advocacy on toxic stress for our

pediatricians, educators, parents, and politicians, we will one day see a world where at-risk

children can overcome adversity.

Works Cited

Arruabarrena, Ignacio, and Joaquin De Paul. "Early Intervention Programs for Children and

Families: Theoretical and Empirical Bases Supporting Their Social and Economic

Efficiency." Psychosocial Intervention 21 (n.d.): 117-27. Colegio Oficial De Psiclogos

De Madrid, 8 Jan. 2014. Web. 3 Apr. 2016.

Felitti, Vincent J., and Robert F. Anda. "Relationship of Childhood Abuse and Household

Dysfunction to Many of the Leading Causes of Death in Adults- Adverse Childhood

Experiences Study." American Journal of Preventative Medicine (1998): n. pag. Web. 1

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"The Fight or Flight Response - 5 Minute Stress Mastery." The Fight or Flight Response - 5

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Isaacs, Stephen L., and Steven A. Schroeder. Class The Ignored Determinant of the Nations

Health. Boise, ID: Sounding Board, 2004. Web. 4 Apr. 2016.

Karr-Morse, Robin. Scared Sick: The Role of Childhood Trauma in Adult Disease. N.p.: Basic,

n.d. ProQuest Ebrary. Jan. 2012. Web. 30 Apr. 2016.

Kilburn,, Rebecca, and Lynn Karoly. "What Does Economics Tell Us About Early Childhood

Policy?" The Economics of Early Childhood Policy: What the Dismal Science Has to Say

About Investing in Children. The RAND Corporation, 2008. Web. 30 Apr. 2016.

Machlin, Steven R. Expenses for a Hospital Emergency Room Visit, 2003. Issue brief no. 111.

N.p.: Agency for Healthcare and Quality, n.d. Print.

Shonkoff, J. P., A. S. Garner, B. S. Siegel, M. I. Dobbins, M. F. Earls, A. S. Garner, L. Mcguinn,

J. Pascoe, and D. L. Wood. "The Lifelong Effects of Early Childhood Adversity and
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Shonkoff, Jack P., and Susan N. Bales. Ersistent Fear and Anxiety Can Affect Young Childrens

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Shonkoff, Jack P., and Susan N. Bales. "Result Filters." National Center for Biotechnology

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Arruabarrena, Ignacia, and Joaqun De Pal. "Early Intervention Programs for Children and

Families: Theoretical and Empirical Bases Supporting Their Social and Economic

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of Human Health and Disease. American Academy of Pediatrics, n.d. Web. 4 Apr. 2016.

Shonkoff, J. P., A. S. Garner, B. S. Siegel, M. I. Dobbins, M. F. Earls, A. S. Garner, L. Mcguinn,

J. Pascoe, and D. L. Wood. "The Lifelong Effects of Early Childhood Adversity and

Toxic Stress." Pediatrics 129.1 (2011): n. pag. Web. 4 Apr. 2016.

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